Gallstone disease history and symptoms: Difference between revisions

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==Overview==
==Overview==
The majority of patients with gallstone disease are asymptomatic and do not feel any pain or discomfort. These gallstones are called "silent stones" and do not affect the [[gallbladder]] or other internal organs. They do not need treatment.<ref name="nih_gall" /> Unless a complication occurs, gallstones will remain asymptomatic. Most patients females over the age of 40 whom have had multiple children and tend to have a BMI over 25. <ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref>
Gallstone disease can manifest in a number of ways. Most patients have a history of [[obesity]], [[Pregnancy|multiple pregnancies]], use of [[Oral contraceptive|oral contraceptive pills]], [[Ageing|age]] of 40 years old and over, female and of Caucasian or Native American race. Some patients may be in a physical state that favors the development of gallstones but don't develop them, some patients may have gallstones, but are [[asymptomatic]]. These gallstones are detected incidentally. Some may have gallstones and experience biliary colic, [[Nausea and vomiting|nausea]], [[Nausea and vomiting|vomiting]] and [[diarrhea]], whilst others will have complications due to gallstones, such as [[acute cholecystitis]] and [[acute pancreatitis]].  
 
==History and Symptoms ==
==History and Symptoms==
 
The majority of patients with gallstone disease are asymptomatic.<ref>{{cite web |url=http://www.emedicine.com/med/topic836.htm#section~clinical |title=Cholelithiasis |accessdate=2007-08-25 |work=emedicine from WebMD}}</ref> They start developing symptoms once the stones reach a certain size (>8mm).<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref>The hallmark of gallstone disease is a gallstone "attack", also known as '''biliary colic''' that is described as intense pain in the upper abdominal region that steadily increases for approximately thirty minutes to several hours with pain in the back, ordinarily between the shoulder blades, or pain under the right shoulder. Eventually, the pain subsides. A positive history of obesity, multiparity and age over 40 is suggestive of gallstones.<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref>


===History===
===History===
Patients with gallstones may have a positive history of:
* Obtaining history is an important aspect of making a diagnosis of gallstone disease.<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref><ref name="pmid11711412">{{cite journal |vauthors=Johnson CD |title=ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder |journal=BMJ |volume=323 |issue=7322 |pages=1170–3 |year=2001 |pmid=11711412 |pmc=1121646 |doi= |url=}}</ref>
*Obesity
*Eating fatty foods
* The areas of focus should be on onset, duration, and progression of symptoms such as:
*Multiparity
**[[Obesity]]
*Age over 40
**Eating fatty foods
*Female
**[[Parity (medicine)|Multiparity]]
*Caucasian or Native American <ref name="pmid11711412">{{cite journal |vauthors=Johnson CD |title=ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder |journal=BMJ |volume=323 |issue=7322 |pages=1170–3 |year=2001 |pmid=11711412 |pmc=1121646 |doi= |url=}}</ref>
**[[Aging|Age over 40]]
 
**Female
**[[Oral contraceptive|Oral contraceptive pill]]
**Caucasian or Native American race
===Common Symptoms===
===Common Symptoms===
Common symptoms of gallstones include:
*The majority of patients with gallstone disease are [[asymptomatic]].<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |year=1990 |pmid=2368790 |doi= |url=}}</ref><ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000273.htm#Symptoms%20Medline%20Plus |title=Gallstones |accessdate=2007-08-25 |work=Medline Plus}}</ref><ref name="pmid13848582">{{cite journal |vauthors=LUND J |title=Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases |journal=Ann. Surg. |volume=151 |issue= |pages=153–62 |year=1960 |pmid=13848582 |pmc=1613279 |doi= |url=}}</ref>  
*Right upper quadrant pain
*Patients start developing symptoms once the stones reach a certain size (>8mm):
*Nausea
**[[Abdominal pain|Right upper quadrant pain]] or '''biliary colic''': intense [[pain]] in the upper [[abdominal]] region
*Vomiting
*** The [[pain]] steadily increases for approximately thirty minutes to several hours.
*Diarrhea<ref name="pmid13848582">{{cite journal |vauthors=LUND J |title=Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases |journal=Ann. Surg. |volume=151 |issue= |pages=153–62 |year=1960 |pmid=13848582 |pmc=1613279 |doi= |url=}}</ref>
*** [[Pain]] is sometimes referred to the middle of the back or the tip of the right shoulder.
**[[Nausea and vomiting|Nausea]]
**[[Nausea and vomiting|Vomiting]]
**[[Diarrhea]]


===Less Common Symptoms===
===Less Common Symptoms===
Less common symptoms of gallstones include  
Less common symptoms include:<ref name="pmid12802649">{{cite journal |vauthors=Berger MY, Olde Hartman TC, Bohnen AM |title=Abdominal symptoms: do they disappear after cholecystectomy? |journal=Surg Endosc |volume=17 |issue=11 |pages=1723–8 |year=2003 |pmid=12802649 |doi=10.1007/s00464-002-9154-6 |url=}}</ref>
*Chest pain
*[[Chest pain]]
*Fullness after eating/early satiety
*Fullness after eating or early [[satiety]]
*Belching<ref name="pmid12802649">{{cite journal |vauthors=Berger MY, Olde Hartman TC, Bohnen AM |title=Abdominal symptoms: do they disappear after cholecystectomy? |journal=Surg Endosc |volume=17 |issue=11 |pages=1723–8 |year=2003 |pmid=12802649 |doi=10.1007/s00464-002-9154-6 |url=}}</ref>
*Frequent [[Burping|belching]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Primary care]]
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Gallstone disease can manifest in a number of ways. Most patients have a history of obesity, multiple pregnancies, use of oral contraceptive pills, age of 40 years old and over, female and of Caucasian or Native American race. Some patients may be in a physical state that favors the development of gallstones but don't develop them, some patients may have gallstones, but are asymptomatic. These gallstones are detected incidentally. Some may have gallstones and experience biliary colic, nausea, vomiting and diarrhea, whilst others will have complications due to gallstones, such as acute cholecystitis and acute pancreatitis.

History and Symptoms

History

  • Obtaining history is an important aspect of making a diagnosis of gallstone disease.[1][2]

Common Symptoms

Less Common Symptoms

Less common symptoms include:[5]

References

  1. 1.0 1.1 Diehl AK, Sugarek NJ, Todd KH (1990). "Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis". Am. J. Med. 89 (1): 29–33. PMID 2368790.
  2. Johnson CD (2001). "ABC of the upper gastrointestinal tract. Upper abdominal pain: Gall bladder". BMJ. 323 (7322): 1170–3. PMC 1121646. PMID 11711412.
  3. "Gallstones". Medline Plus. Retrieved 2007-08-25.
  4. LUND J (1960). "Surgical indications in cholelithiasis: prophylactic choleithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases". Ann. Surg. 151: 153–62. PMC 1613279. PMID 13848582.
  5. Berger MY, Olde Hartman TC, Bohnen AM (2003). "Abdominal symptoms: do they disappear after cholecystectomy?". Surg Endosc. 17 (11): 1723–8. doi:10.1007/s00464-002-9154-6. PMID 12802649.

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